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Who can take the Plan?
Any organization/institution having at least 25 insurable members can join the plan. Insurable member includes - employee, their spouse and dependent children provided that at least 95% of its eligible employees/members aged between 18 and 60 years must join the plan. A new employee can join the plan after 90 (ninety) days of continuous active service with the employer.
Fixation of Premium Rate:
Usually premium rates are fixed on the basis of age group, plan option and profession of the group clients. After receiving employees’ particulars the group department calculates annual premium for that particular group using the tariff rate approved by the Chief Controller of Insurance office. The basic information that is required for premium rate calculation is as follows:
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Sl. No. |
Name |
Designation |
Date of Birth |
Plan Option |
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Sometimes, group insurance departments quoted
premium rate on the basis of business experience to certain organization.
Usually these are large organizations, where the numbers of employees are 500 or
more.
Annual Premium
Rate (in Taka)
|
Age attained (Yrs) |
0 – 35 |
36 - 45 |
46 - 50 |
51 - 55 |
56 - 60 |
|
Economy
|
Employee |
550 |
690 |
960 |
1,375 |
1,925 |
|
Spouse |
468 |
587 |
816 |
1,169 |
1,637 |
|
Each child
(Age up to 25 yrs) |
468 |
|
|
|
|
|
Executive
|
Employee |
990 |
1,240 |
1,735 |
2,475 |
3,465 |
|
Spouse |
842 |
1,054 |
1,475 |
2,305 |
2,945 |
|
Each child
(Age up to 25 yrs) |
842 |
|
|
|
|
|
Executive
Plus |
Employee |
1,360 |
1,585 |
2,030 |
2,700 |
3,600 |
|
Spouse |
1,156 |
1,347 |
1,726 |
2,295 |
3,060 |
|
Each child
(Age up to 25 yrs) |
1,156 |
|
|
|
|
|
Corporate
|
Employee |
1,600 |
1,850 |
2,250 |
2,850 |
3,780 |
|
Spouse |
1,360 |
1,573 |
1,913 |
2,423 |
3,213 |
|
Each child
(Age up to 25 yrs) |
1,360 |
|
|
|
|
|
Corporate
Plus |
Employee |
3,200 |
3,600 |
4,400 |
5,700 |
7,200 |
|
Spouse |
2,720 |
3,060 |
3,740 |
4,845 |
6,120 |
|
Each child
(Age up to 25 yrs) |
2,720 |
|
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·
Premium rate is
subject to change from time to time.
· Treatment
facilities in
India is
available by paying 30% additional premium over normal premium rate. Treatment
facilities in
Thailand
including
India is
available by paying 50% additional premium over normal premium rate.
|
Size Discount |
|
Size of Group |
Discount (%) |
|
Up to 100
101 - 500
501 - 1000
1001 - 2000
2001 & Above |
Nil
5
7.5
10
12.5 |
No Claim Discount |
No Claim Years |
Discount (%) |
One Year |
10 |
Two Consecutive years |
20 |
Three Consecutive Years |
30 |
Benefit Schedule
|
Plan
Benefit
yearly (Max.) |
Economy
25,000 |
Executive
50,000 |
Executive
Plus
80,000 |
Corporate
100,000 |
Corporate
Plus
150,000 |
|
Hospital
Stay
(Maximum days) |
14 |
14 |
18 |
21 |
21 |
|
Room
Rent
(Actual or
Max. Taka Per Day) |
600 |
1,200 |
1500 |
2,000 |
2,000 |
|
Consultation Fee
(Actual or
Max. Taka Per Day) |
300 |
500 |
500 |
500 |
600 |
|
Routine
Investigations
(Actual or
Maximum) |
1,000 |
1,200 |
1,500 |
1,500 |
2,000 |
|
*Medicines
(Actual or
Maximum Taka) |
5,000 |
10,000 |
12,000 |
15000 |
18,000 |
|
Surgery
(Actual or Max. Tk.)
Major
Intermediate |
14,000
8,000 |
15,000
10,000 |
16,000
12,000 |
20,000
12,000 |
22,000
15,000 |
|
Ancillary Services
(80% of
Actual or Max. Taka) |
3,000 |
6,000 |
8,000 |
10,000 |
12,000 |
|
Entertainment Allowance
Actual or
Max. Taka Per Day
Actual or
Maximum Total |
|
|
|
50
600 |
70
1,000 |
|
*Medicines,
in case of Surgical Treatment |
2,000 |
4,000 |
6,000 |
8,000 |
10,000 |
| Limitations:
Maternal benefits for pregnancy or childbirth is covered when the Membership has been in forced for at least ten months under the Plan with the following limitations:
| Level of Benefits |
Normal Delivery |
Caesarean Delivery |
| Economy |
Max. Tk. 4,000 |
Max. Tk. 10,000 |
| Executive |
Max. Tk. 8,000 |
Max. Tk. 20,000 |
However, benefit under Executive Plus, Corporate & Corporate Plus shall be as per Benefit Schedule
Designated Hospitals:
Pragati Life has a group of designated hospitals in all major cities of the country. If any insured member gets admitted in these hospitals, Pragati Life receives certain percentage of discount over room rent, investigation bills and other hospital services from these hospitals.
Moreover, group department is planning to use these hospitals for marketing and selling individual hospitalization insurance plan. In return Pragati Life will allow some financial benefit to these hospitals.
Hospitalization & Claims Procedures
PRAGATI LIFE seeks to settle the majority of claims directly with the hospital where treatment is received as inpatient preferably in its designated hospitals.
If any Member needs hospitalization for treatment, Company’s Medical Advisor will help him/her (if he/she desires) through the process of admission to hospital, confirming with the hospital his/her insurance coverage and arranging direct settlement of the insured expenses. The Member must make a phone call and send Fax/e-mail to the Medical Advisors in advance of any planned admission (with doctor’s advice) and within two working days of any emergency admission.
A) Direct Payment:
If a Member is admitted in a Hospital/Clinic with whom the Company has Direct Payment Agreement, the Company shall pay all expenses incurred for hospitalization treatment within his benefit limit, directly to the hospital/clinic. Expenses not mentioned in the Benefit Schedule or in excess of the Benefit Limit should be borne by the Member himself/herself.
Reimbursement:
a) Reimbursement shall be allowed only for inpatient treatment in specialized/Govt. hospitals or emergency hospitalization including overseas treatments. The Member shall submit claim through ‘Claim Form’ (available with the Plan Secretary) to the Company within 2 (two) months after discharge from the Hospital/Clinic for reimbursement of expenses. The Company shall reimburse to the Employer the actual expense incurred for hospital treatment up to the benefit limit upon receipt of all relevant documents within 7 working days.
The supporting documents usually shall include the following:
Consultant’s recommendation for hospitalization (original) Discharge certificate (original or photocopy duly attested by the hospital) A photocopy of the patient's file while hospitalized (if possible) Money Receipt or Bill of Consultant’s (Physician/Surgeon) fee Bill relating to room charges, investigations and other services where applicable Bill of medicine/drugs Bill relating to Surgical Operation charges (operation theatre, surgical team, delivery charge, anaesthesia & other charges), where applicable Bill relating to ancillary charges (e. g. ambulance service, oxygen therapy, blood transfusions etc.)
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